Elizabeth Mainzer Gagnon, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

8186 Issued in MA

Practice address

77 Franklin St
Suite 809
Boston, MA 02110-1510

Phone

(617) 451-0055

Fax

(617) 451-0055

NPI assigned

Jan 19, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Moonshot Psychiatric Nurse Practitioner PC

  • Psychiatric/Mental Health Nurse Practitioner
  • Seattle, WA
  • NPI 1669158879
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474502400000",
    "number": "1558414060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 FRANKLIN ST",
            "address_2": "SUITE 809",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021101510",
            "telephone_number": "617-451-0055",
            "fax_number": "617-451-0055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 FRANKLIN ST",
            "address_2": "SUITE 809",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021101510",
            "telephone_number": "617-451-0055",
            "fax_number": "617-451-0055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "ELIZABETH",
        "middle_name": "MAINZER",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2016-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "8186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "W06313",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Florence Gagne, MD
• Lisa Gagne
• Makenzie Gagne
• Staci Gagne, M.D.
• Charles Alan Gagnon-Vargas, MD
• Haley Gagnon, PA-C
• James Michael Gagnon Jr., PHARM.D.
• Maria Gagnon
• Marie-Helene Gagnon, MD
• Nicole M. Gagnon, LCSW

• Clinical Psychologist in Boston, MA
• Providers in Boston, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.